Bringing Bellyaching to an End

There's something about digestive difficulties that makes them hard to discuss in polite company--which leaves many of us suffering one problem or another in silence.

Yet fixes can be as simple as making informed lifestyle changes or taking over-the-counter remedies. Peppermint oil and soluble fiber, for example, can help people with irritable bowel syndrome; a study the British Medical Journal published in November concludes that both should be first-line therapies for IBS. Here's a rundown of the latest medical wisdom on some other common gastrointestinal problems.

REFLUX

Symptoms of reflux, such as heartburn, are among the most common digestive ills. In a recent Swedish study, 6 percent of people reported experiencing reflux symptoms daily and 14 percent had them at least weekly. Such frequent symptoms may indicate a person has GERD, or gastroesophageal reflux disease. Aside from being painful, GERD can harm the esophagus over time or even lead to esophageal cancer.

Heartburn typically involves a "hot or burning feeling rising up from the center of the abdomen area and into the chest under the breastbone or sternum," says Michael Gold, director of gastroenterology at Washington Hospital Center in Washington, D.C. "It may be accompanied by a sour taste in the mouth, or hypersalivation, or even finding food or fluid in your mouth," particularly at night. Pregnancy, some medications, and consuming alcohol or certain foods can cause heartburn. Kids under age 12 and some adults may have GERD without heartburn, instead experiencing asthmalike symptoms, trouble swallowing, or a dry cough.

Treatment options include drugs that reduce acid levels, such as the proton pump inhibitors Aciphex, Nexium, Prevacid, Prilosec, and Protonix and the H2 blockers Axid, Pepcid, Tagamet, and Zantac. But taking medication is not without risk. This November, a study found that a proton pump inhibitor may weaken the heart-protective effect of the blood thinner Plavix in patients taking both medications.

In severe cases of GERD, surgeons can tighten a loose muscle between the stomach and esophagus to inhibit the upward flow of acid. Recently, laparoscopic surgery, which involves small incisions, was found to lessen scarring and shorten recovery time compared with open procedures.

PEPTIC ULCERS

If you have unexplained stomach pain, consider this before reaching for a painkiller: "The worst thing to do if ulcers are suspected is to take aspirin or other NSAID [nonsteroidal anti-inflammatory drug] pain reducers," Gold says. "They worsen it and don't help."

Instead, if you think you have a peptic ulcer--and 25 million living Americans will get one at some point--consider getting tested for Helicobacter pylori, experts advise. By disrupting a protective layer of mucus, that bacterium causes ulcers, which are sores in the lining of the stomach or first stretch of the small intestine. Other causes include smoking, which can elevate stomach acidity, and excessive NSAID use. Alcohol use may also be a factor, but it's unclear whether that alone can cause ulcers. (The old theory blaming factors like stress isn't totally wrong: Stress can aggravate symptoms of peptic ulcers and delay healing.)

Left untreated, ulcers can cause internal bleeding and may eat a hole in the small intestine or stomach wall, which can lead to serious infection. Ulcer scar tissue can also block the digestive tract. And long-term H. pylori infection has been linked to an increased risk of gastric cancer.

Ten to 14 days of antibiotic treatment, often combined with acid reduction therapy, can rid someone of H. pylori. Surgery is an option for more severe cases. A study published in November in the World Journal of Surgery concluded that laparoscopic repair should be considered for all patients with so-called perforated ulcers.

GALLSTONES

Only a quarter of people with gallstones typically require treatment. That's fortunate, because every year nearly 1 million Americans are diagnosed with these little pebbles, which are primarily made of cholesterol and bile salts. Getting rid of them typically requires removal of the gallbladder, one of the most common U.S. surgeries.

Gallstones can get blamed for symptoms caused by other, more elusive culprits, such as irritable bowel syndrome, says Robert Sandler, president of the American Gastroenterological Association. An ultrasound test might pick them up while missing the real problem. If you're told you need to have gallstones out but they're not bothering you, get a second opinion, he advises.

Removal may be necessary if the stones instigate inflammation or infection of the gallbladder, pancreas, or liver. This can happen if a stone moving out of the gallbladder gets stuck--blocking the flow of bile--in the ducts between the liver and the small intestine.

The pain of a gallstone lodged in a duct usually comes on quickly--in the right upper abdomen, between the shoulder blades, or under the right shoulder--and means a trip to the ER is needed, as may fever, vomiting, nausea, or pain lasting more than five hours. Gallbladder removal can be performed laparoscopically and more recently has been done without an external incision by going through the mouth or vagina.

Obesity is a risk factor for gallstones, and it's theorized that they develop because of a shortage of fiber and an excess of fat in the western diet. Losing weight--then regaining it--also seems to set the stage for gallstones. In a 2006 study of men, the more frequent the weight cycling and the larger the number of pounds shed and regained, the greater the odds of gallstones. Women, especially those who are pregnant or taking birth control pills, face increases in gallstone likelihood as well.

LACTOSE INTOLERANCE

Between 30 million and 50 million Americans are lactose intolerant, meaning they lack an enzyme needed to digest the main sugar in milk, and African-Americans, Asians, and American Indians are most likely to have the condition. Ranging in severity from person to person, symptoms include cramping, bloating, gas, nausea, and diarrhea. These usually occur 30 minutes to two hours after one drinks or eats a dairy product.

Doctors can test for lactose intolerance using a breath test, which detects heightened levels of hydrogen; a blood test, before which the patient drinks a lactose-containing beverage; or a test of stool acidity (which undigested lactose helps generate). There's also a cheaper, do-it-yourself approach to diagnosis, says Stephen Bickston, an American Gastroenterological Association fellow and professor of internal medicine at the University of Virginia. "Buy a tall container of milk, drink it, and call me the next day and tell me how the afternoon was," he says. If you experience bloating, abdominal pain, or diarrhea, he says, you're probably lactose intolerant.

If so, don't despair. Over-the-counter pills can replace the missing enzyme, called lactase, and some milk and milk substitutes are lactose free. Avoiding all dairy products, in any case, may not be necessary. Many lactase-deficient people "can tolerate small amounts of lactose," Bickston says.

DIVERTICULITIS

By one estimate, 3 in 5 Americans older than 70 have the abnormal bulges called diverticula somewhere in the wall of their intestinal tract. Yet only 20 percent will ever experience a complication like diverticulitis (inflammation of a pouch), a tear, or an abscess.

Doctors have long advised people with diverticula to avoid nuts, corn, and popcorn for fear those foods would get lodged in a pouch during digestion and wreak havoc. But in August, research published in the Journal of the American Medical Association found that regular consumption of these foods did not boost the risk of diverticular complications. In fact, eating plenty of nuts and popcorn seemed to lower risk.

When diverticulitis does arise, it's very likely to make its presence known through abdominal pain--typically in the lower left quadrant in westerners, but often on the right side in Asians--and possibly fever; antibiotics can treat the condition. In extreme cases, a tear can lead to an abscess, which can cause nausea, vomiting, fever, and intense abdominal tenderness that requires a surgical fix. Some experts believe a diet too low in fiber may trigger the condition, which grows increasingly common with age and is most prevalent in western societies.

People with Crohn's disease or ulcerative colitis, the two most common inflammatory bowel diseases, complain of abdominal pain and diarrhea and sometimes experience anemia, rectal bleeding, weight loss, or other symptoms. No definitive test exists for either disease, and patients endure two initial misdiagnoses on average, says R. Balfour Sartor, chief medical adviser to the Crohn's & Colitis Foundation of America. With Crohn's, he says, appendicitis, irritable bowel syndrome, an ulcer, or an infection is often wrongly suspected.

Both disorders may arise from a wayward immune system that leads the body to attack the gastrointestinal tract. Crohn's involves ulcers that may burrow deep into the tissue lining at any portion of the GI tract, leading to infection and thickening of the intestinal wall and blockages that need surgery. Ulcerative colitis, by contrast, afflicts only the colon and rectum, where it also causes ulcers; colitis is characterized by bleeding and pus.

Treating either disease requires beating back--and then continuously holding in check--the inappropriate inflammatory response. Both steps are achieved through some combination of prescription anti-inflammatories, steroids, and immunosuppressants. Crohn's patients may also be given antibiotics or other specialized drugs. Of current hot debate is whether Crohn's sufferers benefit if given highly potent drugs early in the course of treatment as opposed to escalating potency over time from milder initial treatments, as is traditionally done, explains Themos Dassopoulos, codirector of inflammatory bowel diseases at Washington University in St. Louis.

Surgery "cures" ulcerative colitis by removing the colon but means patients must wear a pouch--internally or externally--for waste. IBD patients should take special care when popping NSAIDs like aspirin, as these painkillers can trigger further gut inflammation in 10 to 20 percent of patients, says Dassopoulos.

CONSTIPATION

The fact that Americans spend $725 million a year on laxatives suggests that trying to unclog the nation's plumbing, so to speak, is almost a national pastime. But overuse of stimulant laxatives, which cause the intestines to contract rhythmically, can make the gut dependent, requiring more of the drug and eventually rendering the aid ineffective.

First, a bit of clarification on the, um, frequency of your flushing: There's no need to obsess about having a daily bowel movement; anywhere between three times a day and three times a week is normal, says AGA President Sandler.

But if you're experiencing discomfort and can't make your bowels move, try an over-the-counter remedy like good old milk of magnesia, he says. And whether you've tried laxatives or not, going a week without a bowel movement is good reason to visit the doc, says Sandler. Constipation, hard stools, and straining could lead to hemorrhoids or an anal fissure.

Constipation is best avoided through regular exercise and a diet high in fiber from whole grains, fruits, and vegetables. To older folks, who tend to get constipated more frequently: Be sure you're hydrating properly and aware of any medications that might be causing the holdup.